Cerebellar anatomy as applied to cerebellar microsurgical resections

Abstract

The cerebellum is an exquisite anatomic structure within the human brain, which needs to be considered from the surgical standpoint because of its functional importance and common pathologies that affect this area 1 . It is possible to reach the cerebellum avoiding damaging neural structures by approaches which target tentorial, petrosal, or suboccipital surfaces. Each has its microsurgical particularities in order to reach the desired region and preserve neural structures 2 . In this article, we have presented the microsurgical anatomy of the suboccipital and supracerebellar approaches to the cerebellar surfaces using comprehensives anatomic and functional relations with the final objective of performing better operations with less damage to the cerebellar nucli and important deep pathways. MetHODSThe dentate nucleus, cerebellar peduncles and their relationship with others cerebellar structures were studied in 20 adult cerebellar hemispheres, 12 male and 8 female corpses, obtained from São Paulo death verification service using X3 to X40 magnifications. AbStrActObjective: To define the anatomy of dentate nucleus and cerebellar peduncles, demonstrating the surgical application of anatomic landmarks in cerebellar resections. Methods: Twenty cerebellar hemispheres were studied. Results: The majority of dentate nucleus and cerebellar peduncles had demonstrated constant relationship to other cerebellar structures, which provided landmarks for surgical approaching. The lateral border is separated from the midline by 19.5 mm in both hemispheres. The posterior border of the cortex is separated 23.3 mm from the posterior segment of the dentate nucleus; the lateral one is separated 26 mm from the lateral border of the nucleus; and the posterior segment of the dentate nucleus is separated 25.4 mm from the posterolateral angle formed by the junction of lateral and posterior borders of cerebellar hemisphere. Conclusions: Microsurgical anatomy has provided important landmarks that could be applied to cerebellar surgical resections.Key words: cerebellum, anatomy, neurosurgery.reSuMO Objetivo: Definir a anatomia do núcleo denteado e dos pedúnculos cerebelares, demonstrando a aplicação dos marcos anatômicos em cirurgias cerebelares. Métodos: Foram estudados 20 hemisférios cerebelares. Resultados: A maioria dos núcleos denteados e pedúnculos cerebelares demonstraram relação anatômica constante com outras estruturas cerebelares, fato que proporcionou o estabelecimento de marcos anatômi-cos específicos a serem utilizados em acessos cirúrgicos. O bordo lateral do núcleo denteado é separado da linha média em 19,5 mm em ambos os hemisférios cerebelares. O bordo posterior do córtex é separado do segmento posterior do núcleo denteado por 23,3 mm. O bordo lateral do córtex é separado do bordo lateral do núcleo por 26 mm e o segmento posterior do núcleo denteado é separado por 25,4 mm do ângulo posterolateral, que é formado pela junção dos bordos lateral e posterior do hemisfério cerebelar. Conclusões: O estudo da anatomia microcirúrgic...

Causal relationships between migraine and microstructural white matter: a Mendelian randomization study

“…Migraine leads to decreased OD of left superior cerebellar peduncle and decreased MO of right uncinate fasciculus. The superior cerebellar peduncle contains the main efferent fibers of the cerebellum [ 57 ]. It integrates the information from the cerebellum to thalamus that subsequently relays the information to cortical regions [ 58 , 59 ].…”

Endoscope-Assisted Neuroportal Transcerebellar Approach to the Fourth Ventricle: An Anatomical Study

“…Thus, neurosurgeons should consider their relative positions and functional connections by planning transcerebellar routes to the fourth ventricle. 4,7,[43][44][45] According to these observations, surgical dissection through the tonsillobiventral fissure according to the supratonsillar approach or splitting of the inferior vermis may result in DN and DRT tract injury, leading to postoperative neurological morbidities known as "posterior fossa syndrome." 5,[46][47][48][49][50][51][52][53] On the contrary, the DN is spared approaching the fourth ventricle through the cerebellomedullary fissure via the telovelar surgical path, as first described by Matsushima et al 54 The great advancements in endoscopic techniques have led to further less invasive approaches with limited transection of the brain parenchyma, which have minimized the risk of damages to these eloquent areas.…”

The art of combining neuroanatomy and microsurgical skills in modern neurosurgery

“…The patient underwent microsurgical treatment in a semi-sitting position, and the approach chosen was a supracerebellar infratentorial with transtentorial resection. Figure 8 details the correlation between a cadaveric specimen and the steps during the surgery ( 24 , 25 ). As we can see, training the exposure in the laboratory before in a real patient let the neurosurgeon learn how to position the hands, open the skin, the extension the craniotomy, the space generated during the supracerebellar infratentorial approach, which structures the neurosurgeon will find after opening the tentorium, and which instruments he needs to improve the treatment of the condition, in this case, an AVM.…”